Organization
TRACY IRENE DAVIDSON
Active
Organization
TRACY IRENE DAVIDSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY DAVIDSON (OWNER)
(208) 255-6804
Entity
Organization
Contact information
Practice address
493493 HIGHWAY 95 RD, NAPLES, ID 83847-4913
(208) 255-6804
Mailing address
493493 HIGHWAY 95 RD, NAPLES, ID 83847-4913
(208) 255-6804
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
12/22/2014
Last updated
01/02/2015
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